I work in an outpatient department at a small rural hospital (about 70 bed). We do outpatient infusions along with a variety of other procedures. Our director would like to send two nurses to get training to insert PICC lines. The training would be an online course and a hands on class that lasts one or two days. I am considering doing this but I am worried about a couple things. First of all I am wondering if this is enough training to become proficient at inserting PICCs on our own. Right now there is no one at our hospital that has any experience inserting, so after the training we would be completely on our own. Second I am worried that we would not have the volume of patients to stay proficient at inserting. In my estimation we might have 2 or 3 patients a month that would need a PICC. Can anyone with some experience in this area help me out with some advice? I would like to do this but I don't know how hard it is and how much practice it takes to get good at it.
May 21, '10
Modern PICC insertion can seem overwhelming at first especially with all the new technologies such as US and TLS (tip locating Systems). I have trained many nurses that come from our sister hospitals and they tell me that at first they are shocked at just exactly how much is involved and how much skill it really does take. But here is the BIG issue...its a lot of FUN and if you have the interest you have to start somewhere....and it a wonderful and marketable skill to have. Optimally, you should have a background in venipuncture and IV Therapy or it may be more challenging. I would be a little concerned that you essentially DO NOT have any seasoned RN as back-up because you will as a PICC inserter be held to the same standard as any other nurse placing PICCs. Research has shown that it takes at least 20-50 PICC insertions using Ultrasound technology to feel comfortable and about 50 PICCs per year to maintain that competency. Each state in the US has some kind of statement regrading PICC lines and you need to find out what it says. I say GO FOR IT..take the class.....and find out how many PICCS you actually can insert with the RN trainer with real patients...a simulation will not work for you. You also will need to find a resource PICC nurse that will be available should you have any questions or problems in the clinical setting and they do not necessarily need to be at your hospital although that is ideal. Your hospital must have current policies and procedures in place for PICC insertion care and maintenance. Make certain the hospital supports you in the way you need to be supported...you do not want to get yourself in a situation that you feel you do not know what you are doing. So Go..see what it is all about and if you have passion for it..go for it..and keep on learning. I would be happy to answer any questions you have as I have been inserting PICC since 1989..and please let the hospital know that you you will not insert without the use of a bedside Ultrasound unit. I placed PICCs for many yrs just using old fashioned palpation to hit the veins and you have to be a sharp shooter to do it that way and the complication of early stage mechanical is prevalent. ESMP is virtually eliminated with the use of bedside US
Jun 4, '10
Thanks! I'm transitioning into this field and I find this very helpful.
Jun 9, '10
It can take anywhere from 30-100 PICC insertions before people feel truely competent. Remember, it's not so much of an issue when things go right....it's the ability to quickly run all the possible senarios through your head and deal with the times things don't go well.
I agree with many of the comments in response above.
There's alot to this, not the job for everyone, however, those who do it usually enjoy it. My concern is that you spend long enough with an established PICC RN looking over your shoulder. Here, we insist that the trainee does 3 non-assisted PICCs before they go out on their own. That can take 15-20 insertions. This isn't the type of thing you can only do on occasion. I suggest starting with a mini-study as to how many people would really need a PICC in a month. Sometimes "if you build it, they will come"! Is TPN used? ABX IV over a week? Chemo given? All of these people could benefit from a PICC.
If there will be enough call for a PICC RN, how much money are they going to invest in this? A vascular purpose U/S costs in the $20000-$40000 range, or are they thinking you will use an U/S already in Medical Imaging?
It sounds like you aren't using PICCs at all right now. Who will decide what you'll be using? How much education will be available through that company? I've only dealt with BARD and find them pretty good for assistance and education. (Same goes with an U/S....who's will be bought and what education and support do they provide?) I suggest you check out IV-Therapy.net if you aren't familiar with it. Good luck
Jun 9, '10
Thanks for the advice. We are using PICCs right now. The patients we have either come to us with them or have to drive 45 to 75 miles away to get them inserted. My estimation of 2 or 3 a month is based on about how many patients we see right now with PICCs. I think your comment "if you build it they will come" may be right. This may be something our hospital would use more if it is readily available.